Clinical Quality Improvement Coordinator

This is a fully remote position, open to applicants in Texas.

📋 Description

• Act as a subject matter expert on quality improvement (QI) measures, services, clients, and quality initiatives for both commercial and governmental payers.

• Proactively reach out to patients to pinpoint and resolve quality gaps.

• Inform patients about preventive care practices and assist in scheduling screenings or appointments.

• Support adherence to treatment plans and contribute to enhancing health outcomes.

• Gather quality data through electronic medical records (EMR), claims, and outreach to providers.

• Oversee daily tasks across EMR systems, payer portals, vendor platforms, Guidehealth applications, Microsoft 365, and Teams.

• Work with patient lists, gap lists, sourced health data, and medical records.

• Utilize QI resources such as measure/project instructions, NCQA/HEDIS specifications, coding documents, and quick reference guides.

• Organize tasks effectively to meet quality reporting deadlines and requirements.

• Share information regarding quality performance, obstacles, and improvement strategies both internally and with customers.

• Adhere to established QI workflow policies and procedures.

• Collaborate with customers, payers, and colleagues.

• Engage in departmental and payer-sponsored webinars, training sessions, and support calls.

• Cultivate positive professional relationships with colleagues, customers, providers, and their support staff.

⛳️ Requirements

• An associate degree or higher in a relevant field, or a certified/licensed professional such as CMA or LPN.

• At least 1–3 years of experience in a healthcare environment.

• A minimum of 2 years’ experience in Medicare Advantage quality data abstraction and patient outreach.

• Familiarity with charting or performing data abstraction using EMR systems.

• Understanding of medical terminology, quality measures, and medical billing/coding.

• Technical proficiency in managing health data, as well as in Excel, PowerPoint, and various systems and applications.

• Excellent verbal and written communication skills.

• Strong attention to detail and excellent organizational abilities.

• Capability to meet strict deadlines.

• Ability to work collaboratively with management, colleagues, and clients.

• Reliable internet connection suitable for video calls and internal/external systems, with a minimum of 100 Mbps download and 10 Mbps upload speeds.

• Compliance with security policies and procedures to protect PHI, PII, and company intellectual property.

• Knowledge or experience in quality improvement initiatives and data submissions required by payers.

• Extensive experience with quality database entries and reporting.

• Proficient in interpreting and reporting quality information and training staff.

• Proficiency in EMR software and cloud-based platforms.

🏝️ Benefits

• Fully remote work arrangement.

• Required work equipment provided at no cost.

• Medical, dental, and vision insurance plans.

• 401(k) plan with a 3% employer match for a 6% employee contribution.

• Life and disability insurance coverage.

• Options for voluntary life insurance.

• Employee Assistance Program (EAP).

• Paid time off plans.

• Paid parental leave.

• Resources for professional learning and development.